We need to implement shoe decontamination interventions

“You pass through places and places pass through youBut you carry them with you on the soles of your traveler's shoes”— “The Littlest Birds“ by The Be Good Tanyas

I know we really shouldn't be looking for other interventions to reduce pathogen transmission in hospitals since we're too busy eliminating contact precautions at the moment. But I can't resist highlighting this recent systematic review on contamination of shoe soles from Tasnuva Rashid and colleagues published in the Journal of Applied Microbiology.

The authors reviewed the published literature from 1946 through 2015 to identify studies evaluating (1) shoes as vectors for infectious pathogens and (2) evidence on possible decontamination strategies. Their extensive review identified 13 studies (10 cross-sectional and 3 longitudinal) for inclusion. Three studies were completed in hospitals. One study found methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on 56% of physicians' shoes before rounds and 65% after rounds. Two additional studies found significant contamination of operating theater shoes with pathogens including staphylococcus, streptococcus and bacillus species. It doesn't get any better when looking at shoes worn in the community with significant contamination by Clostridium difficile (40%), Listeria species, Salmonella species, and Escherichia coli. I won't even mention the contamination found on the shoes of folks that work with animals.

Possible interventions evaluated include placing chemical filled mats in operating rooms and ward entry points, and shoe covers. While the reviewed studies suggest possible benefits for these interventions, more studies are needed. Of course, you know where I'm heading based on my intro paragraph. We need to implement shoe covers and chemical mats immediately in all hospitals. The data is clearly just as compelling as eliminating contact precautions based on single center studies. Oh, and we can fund these new shoe-targeted interventions using the savings generated through the elimination of contact precautions. Awesome!

Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands). This post originally appeared at the blog Controversies in Hospital Infection Prevention.

Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness.
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